Entries in Riddle, Clive (293)

Friday
Apr062018

The PBM side of CVS

The PBM side of CVS
 

By Clive Riddle, April 6, 2018

 

Assuming the CVS acquisition of Aetna clears all final hurdles, perhaps the most attention given to the merged company is in respect to the retail synergies. But the CVS Caremark PBM also deserves considerable attention. After all, Cigna’s big merger recently announced with Express Scripts was purely a PBM play.

 

With that in mind, its interesting to poke through the just released 14-page CVS Health Drug Trend Report 2017. Similar to Express Scripts previously released 2017 report, the CVS Health report was certainly positive, and they touted that drug prices for clients  rose “at a minimal 0.2 percent, despite manufacturer price inflation near 10 percent.”

 

But it must be noted that the touted 0.2 percent increase was just for prices. There was 1.7% cost growth due to utilization, yielding a total pmpy drug trend in 2017 of 1.9%, still quite a positive trend.

 

Here is additional data CVS shared about their client experience in 2017:

·         While CVS drug price growth was 0.2%, the manufacturer AWP inflation rates were 9.2& for traditional brands, 8.3% for specialty brands, and 0.4% for generics.

·         The CVS generic dispensing rate was 86.1%.

·         CVS traditional and specialty brands accounted for 14% of prescriptions dispensed, but 69% of pharmaceutical spend.

·         The CVS specialty trend consisted of 3.7% price growth plus 9.2% utilization cost growth for a total 12.9% 2017 specialty trend.

·         CVS gross client costs pmpm were 108.42 pmpm in 2017 compared to $104.10 in 2016.

·         For CVS Clients with managed formularies, costs were $88.94 pmpm compared to $87.43 pmpm in 2016.

·         The managed formulary differential in overall drug trend for 2017 resulted in a 1.7% trend with managed formulary clients compared to 4.2% trend for other clients.

·         42 percent of CVS Health commercial PBM clients spent less on their pharmacy benefit plan in 2017 than they had in 2016.

·         For clients aligned with the company's managed formularies, drug price declined by 0.1 percent, in 2017, as compared to the overall 0.2 percent drug price growth.

·         Member out of pocket costs pmpm declined from $11.99 in 2016 to $11.89 in 2017.

·         In 2017 24% of members had zero out of pocket costs (no claims), 49.4% of members had out of pocket costs under $100, 14.6% had out of pocket costs between $100-$299, 5% had out of pocket costs between $300 - $499, 4.3% between $500-$599 and 2.7% above $1,000.

 
Friday
Mar302018

Wal-Mart and Humana: How Healthcare on Wall Street Imitates Hollywood

Wal-Mart and Humana: How Healthcare on Wall Street Imitates Hollywood
 

 

By Clive Riddle, March 30, 2018

Hollywood notoriously chases a hot movie trend with much more of the same – imitation being the most sincere form of flattery.  Wall Street when it comes to healthcare continues to flatter Hollywood by imitating this strategy as best they can.

 

In the 1980s, public hospital companies rushed to acquire health plans. They subsequently rushed to spin-off or otherwise unload them. That’s how Humana become just a health plan company. In the 1990’s, the PPM industry was born as integrated delivery systems where split up, giving birth to PhyCor an others who subsequently flamed out.

 

More recently, on the heels of ACA implementation, the mantra was to increase clout to succeed in the Marketplaces and expanding Medicaid and Medicare Advantage programs. Aetna announced the Humana acquisition and Centene announced the HealthNet acquisition within a day of each other in early July 2015. Three weeks later Anthem announced the Cigna acquisition.

 

Then in February 2017, Aetna-Humana and Anthem-Cigna separately announced on the same day the death of their proposed mergers, thanks to DOJ opposition, and in Anthem-Cigna’s case, merger indigestion. Additionally, the new Trump administration and Republication Congress’ zeal for Repeal made the merger’s marketplace strategy seem moot.

 

But a year later a new blockbuster movie formula has developed. There is Amazon style retail market disruption looming over the pharmacy sector in particular but the rest of healthcare as well, and the specter of the mysterious Amazon-BershireHathaway-JPMorgan healthcare venture. There is the outcry over pharmaceutical costs, and the questioning of the PBM sector’s role.  From this backdrop the CVS-Aetna merger emerges in early December.  Then early this month Cigna announces their Express Scripts acquisition.

 

And now the Wall Street Journal and many others report Walmart is in early stage acquisition talks with Humana. WSJ notes the annual revenue of WalMart is $500 billion and Humana’s is $54B, compared to $185B fir CVS, $61B for Aetna, $42B for Cigna and $100B for Express Scripts.

 

Will the Walmart-Human movie deal get inked? Will any of these new projects make it through production and get released? And what sequels and similar projects are under development?

 
Friday
Mar232018

Animal Farm Meets Health Care

Animal Farm Meets Health Care
 

By Kim Bellard, March 23, 2018

 

 

In George Orwell's classic Animal Farm, the animals revolt against their human masters, and establish a classless society with the inspiring principle, "All animals are equal."  As events play out, their society devolves into a dictatorship with a ruling elite, and the principle becomes "All animals are equal, but some are more equal than others."

This, surprisingly, makes me think of health care.  

 

I am old enough to remember when maternity coverage was at best only very limited even in employer group health plans.  It took the Pregnancy Discrimination Act (1978) to require them to treat maternity the same as any "illness," and, even then, individuals plans often did not include it until ACA required it Similarly, coverage for mental health was typically skimpy until the Mental Health Parity Act (2008) required parity.

Preventive services were usually only available for (the small percentage of) people enrolled in HMOs, until network-based managed care plans grew more widespread in the 1990's.  The same happened with prescription drug coverage, which used to only be available to the minority of people with "major medical" coverage.

It took the Affordable Care Act to standardize what "essential benefits" should be included in health plans.
For services like dental, vision, or hearing, not so much.   Evidently, some services are more equal than others.

We've managed to push our rate of people without health insurance to 
around 11%, but it's more than double that for dental insurance, and worse yet for vision coverage.  For seniors, the figures are significantly worse

The real question should be, why do we have separate coverages for services like dental or vision, especially when many lack them?

This matters.  
According to NCHS, 14% of Americas report hearing trouble, 9% vision trouble -- and 7% have no natural teeth left (25% for those over 75).  There is a well documented link between oral health and our overall health, yet a study found that dental care had the highest financial barriers to care, compared to other health services.

 

If you break a bone, you'll see a doctor; if you break a tooth, you'll see a dentist.  If you have problems with your throat, you'll see a doctor; if you have problems with your gums, you'll see a dentist.  If you want to correct your vision with glasses, you'll see a optometrist; if you want to correct it with Lasik, you'll see a physician.

 

Specialization is understandable, as most physicians end up doing, but I have to wonder why some types of specialization start at the beginning of training, rather than after the basic medical training (see my previous article on balkanized medical education).

We accept all this because, well, that's the way it always has been.  That doesn't mean it makes sense, or that it is best for our health.

We each only have one body.  Although some health issues are fairly specific, we are increasingly realizing that many are systems issues involving multiple parts of the body.  It's time to stop drawing artificial distinctions between what care we get, who gives it to us, and how those professionals get trained. 

Health is not equal to health care.  Health care should not be limited to medical care.  We need to get past "historical accidents" and focus on what is best for our health, and our care.

Unless you actually do believe that all health services, and all health care professionals, are equal, but some are more equal than others.

 

This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting

 
Friday
Mar162018

National Healthcare Measures: A lot of Improvement Overshadowed By Obesity and Diabetes

National Healthcare Measures: A lot of Improvement Overshadowed By Obesity and Diabetes
 

By Clive Riddle, March 16, 2017

On this Ides of March the CDC
National Center for Health Statistics released Selected Estimates Based on Data From the January-September 2017 National Health Interview Survey with great data covering measures fifteen different selected topics. We selected a key statistic from ten of the topics to share below.

What’s striking is that despite our marked improvement in most topics during the past two decades, the percentage of persons reporting they had excellent health didn’t improve (although half a percentage point better than ten years ago, it is two percentage points lower than twenty years ago.)

The culprits in the case must be due in a large part to the fact we living large(er). Two topics below in which increasing percentages aren’t a good thing are obesity and diabetes, but increase we did. We can make policy and administrative changes that impact the percentage of people with insurance, access  care, receive vaccinations, promote exercise and promote smoking cessation. Obesity and Diabetes seem  tougher to tackle.

·         Percentage of persons without health insurance coverage: 2017  9.0% | 2007 14.5% | 1997 15.4%

·         Percentage of Persons With a Usual Place to go for Medical Care (Age adjusted):  2017  88.1% | 2007 86.5% | 1997 86.3%

·         Percentage of persons of all ages who failed to obtain needed medical care due to cost at some time during the past 12 months (Age Adjusted): 2017 4.4% | 2007 5.8% | 1997 4.5%

·         Percentage of adults aged 65+ who received an influenza vaccination during the past 12 months (Age Adjusted):  2017 70.6% | 2007 66.8% | 1997 63.1%

·         Percentage of adults aged 65 and over who had ever received a pneumococcal vaccination (Age Adjusted):  2017 69.9% | 2007 57.8% | 1997 42.6%

·         Prevalence of obesity among adults aged 20 and over (Age Adjusted):  2017 31.4% | 2007 26.6% | 1997 19.5%

·         Percentage of adults aged 18 and over who met 2008 federal physical activity guidelines for aerobic activity through leisure-time aerobic activity (Age Adjusted):  2017 54.8% | 2007 42.0% | 1997 43.3%

·         Prevalence of current cigarette smoking among adults aged 18 and over (Age Adjusted):  2017 14.3% | 2007 19.7% | 1997 24.6%

·         Percentage of persons of all ages who had excellent or very good health:  2017 66.5% | 2007 66.0% | 1997 68.5%

·         Prevalence of diagnosed diabetes among adults aged 18 and over: (Age Adjusted):  2017 8.4% | 2007 7.5% | 1997 5.3%

 
Friday
Mar092018

Perhaps Accenture’s Surveyed Consumers So Willing To Share Healthcare Data Should Read Accenture’s CyberSecurity Survey Report

Perhaps Accenture’s Surveyed Consumers So Willing To Share Healthcare Data Should Read Accenture’s CyberSecurity Survey Report
 

By Clive Riddle, March 9, 2018

 

Accenture has just released a 12-page report with findings from their 2018 Consumer Survey on Digital Health in which they conclude that “Growing consumer demand for digital-based health services is ushering in a new model for care in which patients and machines are joining doctors as part of the healthcare delivery team, and that  “consumers are becoming more accepting of machines — ranging from artificial intelligence (AI), to virtual clinicians and home-based diagnostics — having a significantly greater role in their overall medical care. “

 

Here’s some survey response highlights shared in the report:

·         19% have already used AI-powered healthcare services, with 66% of these consumers likely to use AI-enabled clinical services

·         Consumer use of mobile and tablet health apps has increased from 16% in 2014 to 48% currently.

·         44% have accessed their electronic health records in patient portals over the past year, with 67% of these consumers seeking information on lab and blood-test results; 55% viewing physician notes regarding medical visits, and 41% looking up their prescription history

·         The use of wearable devices by consumers has increased from 9% in 2014 to 33%t currently.

·         75% view wearables  as beneficial to understanding their health condition; while 73% cite them helping engage with their health, and 73% also cite monitoring the health of a loved one

·         90% are willing to share personal data with their doctor, and 88% are willing to share personal data with a nurse or other healthcare professional.

·         72% are willing today to share with their insurance carrier personal data collected from their wearable devices has increased over the past year, compared to from 63% in 2016.

·         47% are willing so share such data and with online communities or other app users today, compared with 38% in 2016.

·         38% are willing to share data with their employer  and 41% with a government agency

 

Interestingly while consumers seem to trust sharing their data most with their doctor and clinical professionals much more than their health plan, another Accenture survey recently released on healthcare cybersecurity found that while overall 18% of healthcare organization employees were willing to sell confidential data to unauthorized parties for as little as between $500 and $1,000; there was considerable disparity between plans and provider offices: 21% from provider organizations would sell confidential data compared to 12% from payer organizations.